摘要
目的 :探讨胫骨结节移位和软骨下骨钻孔术治疗髌股骨关节炎临床疗效。方法 :对 5 5人 5 7个膝关节术前常规拍摄双膝站立位正侧片及 3 0°、60°屈曲的轴心片 ,采用日本腰野分类法。其中髌骨关节狭窄型 3 0例 ,消失型 2 2例 ,软骨下骨磨损型 5例 ,髌骨外移 5 7例。全部病例行胫骨结节抬高 ,平均抬高 1.5cm以及行胫骨结节内移 ,平均内移0 .6cm ,同时行磨损软骨下骨钻孔术 ,孔直径 0 .2cm ,间距 0 .4cm。结果 :随访时间平均 5年 ,结果 5 4人术后平均半年后症状明显改善 ,1人术后 2年疼痛加重。全部病例参考美国膝关节协会评分记录 ,总分为 40分 ,术前平均 12 .4分 ,术后平均 2 7.7分。结论 :髌股骨关节炎的主要症状是疼痛 ,是由异常应力引起的 ,只有纠正髌股关节排列紊乱消除异常应力 ,才能解除症状。对于国人中常见的狭窄外移型的髌股骨关节炎 ,胫骨结节抬高内移手术是比较可靠、值得推荐的。关节软骨自身修复能力很差 ,软骨下骨钻孔术是比较简单有效的方法 ,可促进软骨的修复。 2种手术方法的结合其疗效是相加的 ,最终有利于髌股骨关节炎的恢复。
Objective: Discussing the clinical results of patellofemoral osteoarthritis were followed up after having received the surgical treatment of tibial tubercle osteotomy and subchondral perforative resurfacing. Method: According to the Koshino Knee Osteoarthritis Classification and preoperative roentgenographic presentation of knee in standing posture and patellar skyline views of 30 and 60 degree in flexion, thirty cases showed intrapatellofemoral space narrowing, disappearance in 22 cases and subchondral bone wear out in 5 cases while all the involved kness presented lateral placed patella. All the cases underwent the surgical treatment of osteotonmy for the anatomical alteration of tibial tubercle with 1.5cm in elevation and 0.6cm in medial shifting combined with thesubchondral perforation with each hole 0.2cm in diameter and at intervals of 0.4cm. Result: Mean follow up time were 5 years. Fifty four patients gained the excellent results after a mean period of 6 months postoperatively and only one patient got worse of pain two years after operation. All the cases were recorded by the score system of American Association of Knee. total score was 40, preoperative score was 12.4, postoperative score was 27.7. Conclusion: The chief complaint of patellofemoral osteoarthritis is pain produced by the maldistribution of stress. so the symptom can only be eliminated by rearrangement the patellofemoral alignment in diminishing the extra stress. Tibial tubercle osteotomy is reliabe for the lateral shifted narrowish patellofemoral osteoarthritis which is more common in Chinese patients. Multiple subchondral perforation is relatively a simple and effective method in enhancing the recovery of articular cartilage regarding its poor ability in self repairing. This kind of combined coefficient procedure is advantageous for the recovery of patellofemoral osteoarthritis patients.
出处
《中国矫形外科杂志》
CAS
CSCD
2000年第2期112-114,共3页
Orthopedic Journal of China
关键词
髌股关节
骨关节炎
胫骨结节移位术
治疗
Patellofemoral articulation Osteoarthritis Tibial tubercle osteotomy Subchondral perforation
